2027 Medicare Advantage plan

MedCare Classic (HMO): 2027 benefits and costs

MedCare Partners Health Plan of Texas HMO

CMS plan ID: H5767-001-0 · Plan year: 2027

MedCare Classic (HMO) is a 2027 Medicare Advantage plan offered by MedCare Partners Health Plan of Texas. It is listed in Texas.

2027 plan costs at a glance

Monthly plan premium$0.00

Drug deductible$0.00

In-network medical out-of-pocket maximum$1,500.00

Organization: MedCare Partners Health Plan of Texas
Plan organization: MEDCARE PARTNERS HEALTH PLAN OF TEXAS, LLC
Parent company: MedCare Partners Holding, LLC
Plan type: HMO
Part C premium: $0.00
Part D premium: $0.00
Prescription drug coverage: Yes
2027 CMS Star Rating: Plan too new to be measured

Standard monthly Medicare Part B premium: $209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible: None
In-network medical maximum: $1,500.00

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	What to know
Primary care doctor	$0.00 copay Service-specific deductible No
Specialist visit	$15.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Telehealth	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Emergency care	$150.00 copay
Urgent care	$0.00 copay
Home health	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Dialysis	20% coinsurance Service-specific deductible No	Approval required No Referral required No
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Other Part B drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Kidney disease education services	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Medicare-covered chiropractic	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Medicare-covered foot care	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Other health professionals	$15.00 copay Service-specific deductible No	Approval required Yes Referral required Yes

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
Care	Your share of the cost	What to know
Inpatient hospital stay	$0.00 copay per stay Days 1–4: $200.00 copay per day Days 5–90: $0.00 copay per day	Approval required Yes Referral required Yes Benefit period Per Admission or Per Stay
Inpatient mental health care	$0.00 copay per stay Days 1–4: $200.00 copay per day Days 5–90: $0.00 copay per day	Approval required Yes Referral required Yes Benefit period Per Admission or Per Stay
Skilled nursing facility	Days 1–20: $0.00 copay per day Days 21–100: $221.00 copay per day	Approval required Yes Referral required Yes Benefit period Per Admission or Per Stay

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
Service	In-network	What to know
Outpatient hospital care	$150.00 copay Service-specific deductible No
Hospital observation services	$0.00 copay Service-specific deductible No
Ambulatory surgical center	$100.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Outpatient blood	$0.00 copay Service-specific deductible No	Approval required No Referral required No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	What to know
Diagnostic procedures and tests	$200.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Laboratory services	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Diagnostic radiology (CT, MRI)	$200.00 copay Service-specific deductible No	Approval required No Referral required No
Therapeutic radiology	$0.00 copay Service-specific deductible No	Approval required No Referral required No
X-rays	$0.00 copay Service-specific deductible No	Approval required No Referral required No

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	What to know
Partial hospitalization	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Intensive outpatient program	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Substance use treatment, individual sessions	$15.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Substance use treatment, group sessions	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Opioid treatment program	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Mental health, individual sessions	$15.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Mental health, group sessions	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Psychiatry, individual sessions	$15.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Psychiatry, group sessions	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	What to know
Occupational therapy	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Physical and speech therapy	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Cardiac rehabilitation	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Intensive cardiac rehabilitation	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Pulmonary rehabilitation	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Supervised exercise for peripheral artery disease	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	$0.00 to $200.00 copay Service-specific deductible No	Approval required Yes
Air ambulance	20% coinsurance Service-specific deductible No	Approval required Yes
Durable medical equipment	20% coinsurance Service-specific deductible No	Approval required Yes
Prosthetic devices	20% coinsurance Service-specific deductible No	Approval required Yes
Medical supplies	20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic supplies	20% coinsurance Service-specific deductible No	Approval required No
Diabetic shoes and inserts	20% coinsurance Service-specific deductible No	Approval required No
Diabetic monitors	20% coinsurance Service-specific deductible No	Approval required No

Dental benefits

Dental benefits and member costs
Service	In-network	What to know
Medicare-covered dental	$0
Oral examsAdditional plan benefit	$0
Dental X-raysAdditional plan benefit	$0
Other diagnostic dentalAdditional plan benefit	$0
Dental cleaningAdditional plan benefit	$0
FluorideAdditional plan benefit	$0
Restorative dental careAdditional plan benefit	20% to 50% coinsurance
Root canal treatment (endodontics)Additional plan benefit	20% coinsurance
Gum treatment (periodontics)Additional plan benefit	20% coinsurance
Removable dentures (prosthodontics)Additional plan benefit	50% coinsurance
Maxillofacial prostheticsAdditional plan benefit	20% coinsurance
Oral surgeryAdditional plan benefit	20% coinsurance

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Routine eye examsAdditional plan benefit	$0.00 copay	Approval required No Referral required No
Medicare-covered eyewear	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Contact lensesAdditional plan benefit	$0.00 copay	Approval required No Referral required No
Eyeglass lensesAdditional plan benefit	$0.00 copay	Approval required No Referral required No
Eyeglass framesAdditional plan benefit	$0.00 copay	Approval required No Referral required No

Hearing benefits

Hearing benefits and member costs
Service	In-network	What to know
Medicare-covered hearing exams	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Routine hearing examsAdditional plan benefit	$0.00 copay	Approval required No Referral required No
Hearing aid fitting and evaluationAdditional plan benefit	$0.00 copay	Approval required No Referral required No
Prescription hearing aids (all types)Additional plan benefit	$149.00 copay Service-specific deductible No	Approval required No Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	What to know
Supplemental acupunctureAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Over-the-counter health itemsAdditional plan benefit	$0 Service-specific deductible No
Limited-duration mealsAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Annual physical examAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required Yes Referral required No
Fitness benefitAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required No Referral required No

Allowances and optional benefits

Flex Card

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance: Routine Chiropractic Care; Acupuncture Treatments; Over-the-counter health items; Therapeutic Massage; Restorative dental care; Root canal treatment (endodontics); Gum treatment (periodontics); Removable dentures (prosthodontics); Maxillofacial Prosthetics; Oral and Maxillofacial Surgery; Contact Lenses; Eyeglass frames; Prescription Hearing Aids (all types)
How benefits are provided: Debit Card
Advance choice of benefits required: No
Shared benefit limit: $265.00
How often this limit applies: Every three months
Shared limit on visits or trips: No

Chiropractic & Acupuncture Services

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance: Routine Chiropractic Care; Acupuncture Treatments
How benefits are provided: Claims Processing
Advance choice of benefits required: No
Shared limit on visits or trips: Yes
Indicate number of shared visits/trips: 30
How often this limit applies: Every year

Prescription drug coverage

Costs shown are for initial coverage.

Standard retail costs

Standard retail: initial-coverage cost per prescription fill
Drug tier	30 days	90 days
Tier 1Preferred Generic	$0.00	$0.00
Tier 2Generic	$3.00	$9.00
Tier 3Preferred Brand	$35.00	$105.00
Tier 4Non-Preferred Drug	$100.00	$300.00
Tier 5Specialty Tier	33%	Not listed
Tier 6Select Care Drugs	$0.00	$0.00

Mail-order and other pharmacies

Out-of-network pricing: You pay the standard retail copay or coinsurance, plus any difference between the pharmacy’s billed charge and the amount the plan allows at a standard retail pharmacy.

Standard mail order costs

Standard mail order: initial-coverage cost per prescription fill
Drug tier	90 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$6.00
Tier 3Preferred Brand	$70.00
Tier 4Non-Preferred Drug	$200.00
Tier 6Select Care Drugs	$0.00

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$3.00
Tier 3Preferred Brand	$35.00
Tier 4Non-Preferred Drug	$100.00
Tier 5Specialty Tier	33%
Tier 6Select Care Drugs	$0.00

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier	30 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$3.00
Tier 3Preferred Brand	$35.00
Tier 4Non-Preferred Drug	$100.00
Tier 5Specialty Tier	33%
Tier 6Select Care Drugs	$0.00

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier: Both Part D and Excluded Drugs
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 2: Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 3: Preferred Brand

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 4: Non-Preferred Drug

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 5: Specialty Tier

Drugs included in this tier: Part D Drugs Only

Tier 6: Select Care Drugs

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.

Texas

Harris, Texas